NHCX Overview

Overview

NHCX (National Health Claims Exchange) is the standard platform for exchanging claims and pre-authorization between healthcare providers (hospitals) and payers (insurers / government schemes such as PMJAY). Instead of each hospital talking to each insurer directly, a hospital sends standard FHIR-based bundles to NHCX, which routes them to the correct payer.

Within the system, the NHCX module lets you:

• Check a patient's coverage and eligibility against a payer.
• Submit pre-authorization and claim requests.
• Cancel a pre-authorization.
• Reprocess an erroneous or partially-paid claim.
• Respond to payer communications (queries, payment notices).
• Capture biometric verification (fingerprint / iris / face auth) required for admission and discharge.

Claim lifecycle

A typical NHCX workflow moves through these stages:

1. Eligibility check — confirm the patient's policy, coverage, and benefits.
2. Pre-authorization — get approval for the planned treatment.
3. Admission / treatment — biometric capture at admission, then at discharge.
4. Claim — submit the final claim for reimbursement.
5. Payment / communication — track payment notices and respond to queries.

Prerequisites

Before any NHCX workflow can run, the following must be in place:

• Plan entitlement — NHCX is available on the Hospital, Lab, Enterprise and LargeEnterprise plans, with a valid (unexpired) subscription. Enterprise and LargeEnterprise include it; Hospital and Lab must add the NHCX option to their subscription before they can process transactions. Clinic and Free plans cannot use NHCX. See Pricing & Plans.
• Provider onboarding — the hospital must be registered as an NHCX participant with an active participant code (see NHCX Participant ID Generation).
• HFR ID — a valid ABDM Health Facility Registry ID for the organization.
• Payer discovery — the payers you work with must be discoverable/registered on the exchange.
• Patient ABHA — patients need an ABHA number (and, for biometric flows, Aadhaar-linked mobile).

Registering vs. processing. These are separate rights. Registering a participant code needs a valid subscription but not the NHCX option. Processing pre-authorizations and claims needs the option (or a bundled plan).

Key concepts

Where everything lives

FAQ

Q: Is NHCX the same as ABDM? A: No. ABDM is the broader Ayushman Bharat Digital Mission (health IDs, health records, linking). NHCX is the claims exchange that runs on top of it and uses ABHA numbers for patient identity.

Q: Who uses the NHCX module? A: Hospital admins and front-desk/billing staff who process claims and pre-authorization for patients with covered policies.

Q: What schemes does it support? A: It is payer-agnostic. PMJAY is a common scheme, but any payer registered on NHCX can be used.

Q: Which plans can use NHCX? A: Hospital, Lab, Enterprise and LargeEnterprise. Enterprise and LargeEnterprise include NHCX at no extra charge. Hospital and Lab must add the NHCX option to their subscription — it is a monthly charge shown on the pricing page and added to the subscription total (GST and any yearly discount apply to it). Clinic and Free plans cannot use NHCX.

Q: I registered my participant code but NHCX still says it is not included in my subscription. Why? A: On Hospital and Lab plans, registering a participant code and processing transactions are separate entitlements. Add the NHCX option to your subscription, then sign out and back in — the entitlement is read at login, so an existing session will not see it until you re-login.